Search

Eser, Olcay (Balikesir Author), BACKGROUND: Symptomatic lumbar intervertebral disc herniation (LDH) is rare in children and adolescents. To date, the treatments available for child and adolescent LDH, and the effect of each treatment, have not been fully reviewed. OBJECTIVE: The purpose of this retrospective study is to report the etiology, familial history, presenting symptoms, level of herniation, duration of symptoms, radiological findings, as well as treatment methods and outcome. METHODS: We retrospectively reviewed medical records of all patients with inclusion criteria of being younger than 20 years. (10'19 years); we used magnetic resonance imaging (MRI) to confirm lumbar disc herniations between 2013 and 2016. All patients were followed up for a minimum of 12 months and discharged if they remained almost asymptomatic for 6 months. All patients were treated conservatively and 6 patients they have progressive neurological deficit and persistent back pain, were treated with surgical procedures. The Visual Analogue Scale (VAS), as well as the Oswestry Disability Scale (ODS) and the modified Ashworth Scale (AS) were used to analyze physical examination findings both before and after treatment. To detect lumbar disc degeneration, we used the modified Pfirrmann grading system with MRI. All statistical analyses were performed with commercially available SPSS 15.0 software, while p ≤ 0.05 was considered statistically significant. RESULTS: A total of 70 cases with lumbar disc herniation have been treated. The mean age was 17.14 ± 2.15 years (range 9'19 years). The male to female ratio was 35:35. The mean duration of symptoms was 7.21 ± 1.69 months. The follow-up duration was 17.31 ± 4.17 months. The most common level was L4'5 in 38 (54%) patients and the second was L5-S1 in 24 (34%) patients. Subligamentous protruded discs were found in 42 (60%), extruded in 6 (9%), and disc bulge with intact annulus in 22 (31%) cases. VAS before treatment was 6.05 ± 0.83, while at 6 months after treatment it was 3.1 ± 0.6. However, at the first-year examination, VAS was 2.17 ± 0.76. The ODS was indexed before treatment 42.03 ± 3.75, at 6 months being 25.01 ± 2.75 and at the first year 9.92 ± 2.67. VAS and the OSD were both significantly decreased after treatment (p < 0.05). CONCLUSIONS:Either conservative or surgical methods can be performed comfortably for adolescent lumbar disc herniations. We proposed surgical treatment for patients with incapacitating persistent low back pain or radicular pain that lasted more than 6 weeks, despite rest and medication. We also pursued the development of neurological deficits, including recurrent pain that disturbed routine life activities.

Hydatid cyst (HC) disease is a zoonotic disease caused by the larvae of Echinococcus granulosus. We report our experience of treating HC manifesting aggressive characteristics. Between January, 2010 and December, 2013, 40 patients underwent surgery for HC disease in our department. The subjects of this study were six patients whose disease followed an aggressive and invasive clinical course. The HC disease in these patients involved the vertebrae, chest wall, mediastinum, diaphragm, and lung, with destruction of the lung. There were four men and two women, with a mean age of 47 years (range 12–81 years). Treatment consisted of cystectomy and additional procedures, such as corpectomy and resection of the chest wall, approaching the liver and spleen with phrenotomy and lobectomy. One patient suffered prolonged biliary drainage, and another had a bronchopleural fistula and atelectasis. One patient died of empyema 1 month postoperatively. The mean hospital stay was 9 days. In some patients, HCs can act as an aggressive tumor, involving the surrounding tissues, organs, and even bony structures. Aggressive HCs may cause various sequelae and require extended surgical interventions in addition to cystectomy.

INTRODUCTION Pituitary surgery involving different techniques is often applied to the excision of benign adenomas. Operative interventions involved various approaches and techniques. Endoscopic transsphenoidal approach is the less traumatic route to the sella turcica, avoiding brain retraction, and also permitting good visualization, with lower rates of morbidity and mortality. Although mortality of pituitary surgery decreased by advances in surgical techniques morbidities such as synechiae formation, anosmia, bleeding, nasal septal perforations, drying, and incrustation due to traumatization of the nasal structures such as septum, nasal mucosa, and middle concha are the current problems in pituitary surgery. Here, the authors described an endoscopic transseptal subpericondrial hypophysectomy with minimal damage to normal anatomy and physiology and discussed advantages of this technique. METHODS The authors performed endoscopic transseptal subpericondrial hypophysectomy to 2 patients and evaluated intraoperative and postoperative results. RESULTS No complication was noted during surgery or postoperative period with endoscopic transseptal subpericondrial hypophysectomy technique. CONCLUSIONS Endoscopic transseptal subpericondrial hypophysectomy is a safe technique and, requires only a short surgery time and does not require the removal of any physiological tissue or cause any bleeding.

Eser, Betül (Balikesir Author), "AIM: It has been proposed that apoptosis is effective on intervertebral disc degeneration. This study is the first study in which both polymorphisms and expressions of apoptotic genes in patients with intervertebral disc degeneration (IVDD) are evaluated together. The aim of our study is to determine whether polymorphisms and expressions of apoptotic genes involved in both pathways are related with grades of IVDD or not. MATERIAL and METHODS: Blood and tissue samples of 100 patients diagnosed with lumbar disc degeneration were collected. Patients were divided into 2 groups according to their radiological degeneration grades; grade 2 (mild), and grade 3 and 4 (severe). Polymorphisms in Fas (rs 2234767), Bcl-2 (rs 1801018) and Bax (rs 4645878) genes were determined with real-time PCR. Expressions of these genes were analyzed immunohistochemically following histological degeneration scoring.RESULTS: Whereas no relationship was found among polymorphisms of Fas and Bax genes and their expressions, we have determined a relationship among GG genotype of Bcl-2 and their expressions. Additionally, the ratio of Bax-positive cells was related with IVDD grades. Moreover, radiological degeneration grades were compatible with histological degeneration scores. CONCLUSION: GG genotype of Bcl-2 gene may influence the level of its expression and may be effective on the development of IVDD. Additionally, expression of Bax gene may be related with different grades of IVDD.", Research Fund of Balikesir University

WOS: 000384881000005, PubMed: 27323133, The etiology underlying neural tube defects (NTDs) is not fully understood and is believed to involve a complex milieu of genetic and environmental factors. The A1298C polymorphism in the methylenetetrahydropholate reductase gene (MTHFR) has been associated with mild risk for NTDs. In this study, the genotype distribution of the MTHFR gene A1298C polymorphism and the levels of serum homocysteine, vitamin B12, and folate were evaluated in 33 children with NTDs, their mothers, and 46 healthy controls. Genotyping of the A1298C polymorphism was performed by real-time polymerase chain reaction. The A and C allele frequencies in children with NTDs and their mothers were similar to controls (P = 0.160). The 1298AA and 1298CC genotype frequencies (P = 0.551 and 0.062, respectively) in children with NTDs and their mothers did not differ from controls. On the other hand, the 1298AC genotype frequencies in children with NTDs and their mothers were significantly different from controls (P = 0.025). The genotype frequency of 1298AC was lower in children with NTDs than in controls. There was no significant association between clinical distribution of NTDs and 1298AA/AC/CC genotypes (P > 0.05). Serum vitamin B12 levels were higher in children with NTDs than their mothers and controls (P = 0.001). There were no differences among serum homocysteine and folate levels in all groups (P = 0.494 and 0.141, respectively). Both genetic and nutritional factors are important in the etiology of NTDs. Thus, the A1298C polymorphism cannot be regarded as a major risk factor for NTDs., Kocatepe University Scientific Research CommitteeAfyon Kocatepe University [051.TIP.40], Research supported by the Kocatepe University Scientific Research Committee as project number 051.TIP.40. The authors also wish to thank Afyon Kocatepe University's Foreign Language Support Unit for language editing.

Eser, Olcay (Balıkesir Author), Trauma is a common cause of pneumocephalus, or air in the cranial cavity, and of pneumorrhachis, or the presence of intraspinal air. After spinal surgery, occurrence of pneumocephalus, especially with pneumorrhachis, is extremely rare. We report the case of a patient who developed pneumocephalus and pneumorrhachis after lumbar disc surgery and pedicle screw fixation. There was no cerebrospinal fluid leakage during surgery. On postoperative day 1, the patient complained of headache, nausea, and dizziness. Brain and lumbar computed tomography scans revealed pneumocephalus and pneumorrhachis. With conservative treatment, the patient's complaints resolved within 10 days., yok

Tuberculous osteomyelitis of the spine is most commonly seen in lower thoracic and lumbar vertebrae. Cervical spine tuberculosis is a very rare condition, and it represents a very small part of all patients with Pott's disease. We present a case with thoraco-cervical Pott's disease, with left-sided neck mass and left arm and hand weakness and numbness. The patient had a paraspinal abscess under the sternocleidomastoid muscle that was compressing the brachial plexus.

Vertebral arteries form the basilar artery at the pontobulbar junction. The vertebral artery may have dominancy in one of them. The branches of basilar arteries supply blood for the vestibular nuclei and its connections. Vertigo is seen generally in the upper middle aged patients. Vertigo can be observed in dolichoectasia of basilar artery such as angulation and elongation, because of the diminished blood supply and changed hemodynamic factors of vestibular nuclei and its connections. We hypothesized that angulation or elongation of basilar artery can be estimated according to the unilateral vertebral artery dominant hypertensive patients. The basilar artery can angulate from the dominant side of vertebral artery to the recessive side. These angulation and elongation can effect the hemodynamic factors in absence of growing collateral arteries. So, the vertigo attacks may occur in these patients.

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by anterior and lateral ossification of the vertebral body. We present a case report of central cord syndrome in a patient with DISH after minor trauma. The patient was treated surgically. We also discuss symptomatology and the common mechanism of cord injury in DISH.

Intradural disc herniations, which comprise between 0.1% and .1% of all disc herniations, are very rare [1]. Intraradicular disc erniation was first described in 1984 and only 21 cases have een reported since then [1–6]. This is a rare condition that canot be diagnosed preoperatively and can cause failed back surgery. ntraradicular lumbar disc herniation is generally diagnosed during urgery. In this report, we present the case of a 43-year-old female atient who had severe lower back and left leg pain. Lumbar magetic resonance imaging (MRI) showed an extruded disc fragment ompromising the dural sac at the L1–L2 level. This is the first case f intraradicular lumbar disc herniation at the L1–L2 level to be escribed in the literature.

WOS: 000295823500062, PubMed: 21948754, We investigated a possible association between aggrecan gene polymorphism and lumbar degenerative disc disease in Turkish patients. One hundred 20-30-year-old patients with or without low back pain were selected for the study. Lumbar magnetic resonance imaging was performed on all patients. The patient group had low back pain clinically and degenerative disc disease radiographically. The control group included patients with and without low back pain: all were negative radiographically for degenerative disc disease. Genomic DNA was extracted from all participants. A PCR assay were used to evaluate variable number of tandem repeat polymorphism of aggrecan gene alleles to determine if there was any correlation with degenerative disc disease. Significant associations were found between short repeated alleles of the aggrecan gene and severe disc degeneration. A significant association was also found between short repeated alleles of the aggrecan gene and multilevel disc herniation as well as extrusion and sequestration types of disc herniation. In Turkish population, short repeated alleles of the aggrecan gene are associated with increased disc degeneration and disc herniation., Kocatepe University Scientific Research CommitteeAfyon Kocatepe University [051.TIP.44], The authors thank Murat Acar and Bumin Degirmenci for help with visual assessment of magnetic resonance images. Research supported by the Kocatepe University Scientific Research Committee (Project #051.TIP.44).

WOS: 000280396600061, PubMed: 20589617, Association between neural tube defects (NTDs) and C677T polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene was suspected, because the MTHFR gene codes for a key enzyme in folate metabolism. Its deficiency usually leads to significant reductions in plasma concentrations of folate, vitamin B-12 and methionine, whereas homocysteine levels are increased. We examined folate, vitamin B-12 and homocysteine serum concentrations and polymorphism of the C677T MTHFR gene in Turkish children with neural tube defects. Thirty-three children with NTDs, 26 mothers and 48 healthy individuals were studied. C677T MTHFR polymorphism was determined by melting curve analyses (LightCycler (R)). The levels of folate, vitamin B-12 and homocysteine serum concentrations in NTDs were evaluated and compared, along with information concerning alleles of the MTHFR gene. C677T allele frequencies in NTD children and their mothers were similar to those found in controls. Serum folate and vitamin B-12 concentrations were significantly higher in NTD children than that of controls. Serum homocysteine concentrations were not significantly higher in NTD children and mothers. We concluded that C677T MTHFR gene polymorphism does not affect folic acid, vitamin B-12 and homocysteine metabolism in Turkish children with NTDs. C677T polymorphism of the MTHFR gene cannot be regarded as a major risk factor for NTDs in Turkish children., Afyon Kocatepe University Scientific Research Projects CommissionAfyon Kocatepe University [051.TIP.40], Research supported by the Afyon Kocatepe University Scientific Research Projects Commission (#051.TIP.40).

The aim of this study was to investigate the association between the polymorphisms of the vitamin D receptor (VDR) and aggrecan genes and degenerative disc disease in young Turkish patients. Aggrecan and VDR proteins are the main components of bone and cartilage. In our study, the polymorphisms of the VDR and aggrecan genes were investigated in a total of 300 individuals regarding disc degeneration and herniation. An association was found in the patients having VDR gene TT, Tt, FF, and Ff genotypes with the protrusion type of disc herniation, whereas the patients having tt and ff genotypes were associated with extrusion/sequestration types of the disease. Also, an association was observed between TT and FF genotypes of the VDR gene and mild forms of disc degeneration; and tt, ff, and Ff genotypes and severe forms of the disease. There was also an association between shorter, normal, and longer alleles of the aggrecan gene and a protrusion type of disc herniation. An association was found between short alleles and multilevel and severe disc degeneration, as well as normal and long alleles and mild disc degeneration. This study revealed that the polymorphisms of the VDR and aggrecan genes are associated with disc degeneration and herniation.

The aim of the kyphoplasty method for the treatment of traumatic osteoporotic vertebral compression fractures in geriatric patients is to improve the patient's quality of life. In this report we present two elderly patients who were suffering of traumatic osteoporotic vertebral compression fractures and underwent successful kyphoplasties. Percutaneous kyphoplasty method for the surgical treatment of these fractures decreases the hospitalization, morbidity and mortality in these patients.

This study aimed to investigate the 677CT and 1298AC MTHFR gene polymorphisms and their metabolic effects on the levels of folate, vitamin B12 and homocysteine in the serum of Turkish spina bifida occulta (SBO) patients and healthy individuals in disease.A case-control study was performed to detect 677CT and 1298AC MTHFR gene polymorphisms in 39 SBO patients and 34 healthy individuals. The folate, vitamin B12 and homocysteine concentrations in the serum of SBO and healthy individuals were evaluated and compared with MTHFR gene polymorphisms.677 CC/CT/TT MTHFR genotype frequency differences between the SBO patients and controls were not significant (x(2)=3.325, P=0.068; x(2)=1.479, P=0.224; x(2)=0.275, P=0.600; respectively). 1298AC MTHFR genotype frequency differences between the SBO patients and controls were significant (x(2)=8.477, P=0.004). The frequencies of the Aand C alleles of the 1298AC polymorphism did not differ in a statistically significant manner between the groups (x(2)=0.576, P=0.448). The biochemical parameters were not significantly different between SBO patients and healthy individuals (P0.05).The 677CT and 1298AC polymorphisms of the MTHFR gene cannot be regarded as major risk factors for SBO in the Turkish patients 677TT homozygosity may affect the metabolism of homocysteine.

Five large myelomeningocele defects repaired by bilateral fasciocutaneous flaps are presented in this article.After the neurological repair, bilateral fasciocutaneous flaps were raised, transposed over the midline, and sutured to each other.All operations lasted shorter than one hour and no major complication was noted in the follow-up. Three of the defects were in the thoracolumbar and two in the lumbosacral regions. The areas of the defects were between 5x6 cm (30 cm2) and 8x10 cm (80 cm2).The bilateral fasciocutaneous flap technique offers a shorter operation duration and lower bleeding rate; it is simple to learn and practice and does not abolish alternative operation techniques.

We present a case with median and radial nerve injuries together with brachial artery occlusion after a dog bite that is seen rarely in the literature. A 26 year-old man was admitted to our emergency department with a complaint of dog bite and weakness of fingers at the left upper extremity. There were bite impressions at the left arm. The physical examination of the patient revealed no brachial and radial artery pulse. The neurological examination revealed radial and median nerve deficits. The patient underwent a thromboembolectomy operation following laboratory and radiological evaluations. The nerve injuries were evaluated as partial and medical treatment was administered.

A pneumatocyst in the cervical spine is extremely rare and to our knowledge only a few reports have been published in the English literature. Although the etiology and natural course of vertebral body pneumatocyst is unclear, nitrogen gas accumulation is claimed. A 65-year-old-man was admitted to the emergency department with neck pain and numbness and incapacity in his both hands and fingers. The radiological images revealed a vertebral located pneumatocyst in the C4 cervical vertebra. In this report, we present a case of cervical pneumatocyst located in the C4 vertebral body. The clinical and radiological features and natural course of the pneumatocyst were evaluated.

A 45-day-old infant presented with a rare case of intracerebral hematoma complicated with brain abscess which developed after vitamin K deficiency. He was admitted to our emergency department with complaints of fever and confusion. Physical, neurological, and laboratory examinations and cranial computed tomography identified vitamin K deficiency and intracerebral hematoma. He started to suffer convulsions. The patient underwent surgery. A brain abscess was discovered with an intracerebral hematoma. The intracerebral hematoma and abscess were evacuated and antibiotic therapy was initiated. Convulsions became rare and were controlled with midozalam administration. Follow-up computed tomography after 6 months showed encephalomalacic changes in the temporoparietal area. If feeding depends only on human milk, the amount of vitamin K prophylaxis given to neonates should be increased to support vitamin K related factors.

Intradiploic cavernous hemangioma of the skull is seen rarely. Intradiploic cavernous hemangiomas arise from the intrinsic vasculature of the bone and generally picks up at the fourth and fifth decades. In this report, we present a 16-year-old child who was admitted with a swelling lesion in the right parietal bone and diagnosed as cavernous hemangioma after total extirpation.

Idiopathic transverse myelitis is a monophasic demyelinating disease of the central nervous system (CNS) and its recurrence is a rare entity. Existence of syringomyelia in the spinal cord in inflammatory CNS disease is not usually encountered. This case study describes a 45-year-old man who was admitted with features of a cervical demyelinating disease. The history of the patient indicated that this could be a recurring attack. Cervical MRI and laboratory examination of the patient showed evidence of recurrent transverse myelitis. The patient was managed with medical therapy. The follow-up cervical MRI of the patient 2 years later indicated syringomyelia in the cervical cord.

The diagnosis and management of acute subdural hematoma is important in neurosurgery practice. Rapid spontaneous resolution of acute subdural hematoma within a few hours is seen rarely on the CT scan. We present a case that enlarged the existent subdural hygroma showing rapid resolution of acute subdural hematoma with resolution in 9 hours after the trauma. Additionally, the follow-up CT scans in the 1st month showed the decrease of enlargement of subdural hygroma. The resolution of acute subdural hematoma and effect of acute subdural hematoma on subdural hygroma must be considered during management. The relation of acute subdural hematoma and subdural hygroma is important for the resolution and management of acute subdural hematoma.

Magnetic resonance imaging and magnetic resonance venography findings of 30 women with polycystic ovary syndrome and headache were studied prospectively. Our magnetic resonance imaging and magnetic resonance venography findings support that polycystic ovary syndrome with severe headache is a promoter of idiopathic intracranial hypertension.

Introduction Ventriculoperitoneal shunt operations are the most common pediatric neurosurgical procedures in the treatment of hydrocephalus. However, ventricular shunting is frequently associated with a wide variety of complications. Umbilical perforation is an extremely rare complication of ventriculoperitoneal shunts. Case report We present an infant with umbilical abscess, meningitis, and umbilical perforation of the distal end of the ventriculoperitoneal shunt, which was placed for congenital hydrocephalus.

Objectives An unusual case of hydatid disease is reported. Review of the pertinent literature did not reveal any hydatid disease located simultaneously in both the intracranial and submandibular glands. This is the first case with hydatid disease occurring in both locations at the same time. Study Design The case of an 18-year-old is presented; the symptoms, findings, methods of diagnosis, and our approach for treatment are discussed; and the literature is reviewed. Results The intracranial lesion was completely excised by left-sided frontoparietal craniotomy, and the mass in the right side of the submandibular gland was removed through a submandibular approach at the same session. The intact cyst was completely excised. Histological examination of both lesions confirmed the diagnosis of hydatid cyst by Echinococcus granulosus. Postoperative recovery was uneventful, and the patient was discharged on the seventh day. Conclusions Hydatid cyst should be suspected during the evaluation of cervical masses, particularly in endemic regions. Hydatid disease infestations are best treated with complete excision of the intact cyst.

Case report.We report a rare case of epidural thoracal teratoma in a 7-month-old girl. A total laminectomy was performed via T6–T8 and the lesion was totally excised. Results and discussion. We describe the radiological, surgical and pathological findings in this patient and review the findings in other reported cases.

Six patients received 1 g and six other patients received 2 g of cefoperazone and sulbactam 15 minutes before lumbar disc surgery. Liquid chromatographic analysis of disc tissue revealed that only patients receiving the 2-g dose had mean tissue levels above the minimum inhibitory concentration for Staphylococcus aureus and epidermidis.